North Dakota expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 23,561 of them (5.1% of an expansion pool of 25,187) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.
This model's bottom-up estimate is that 10,994 people in North Dakota lose coverage by 2034: 10,287 of them still eligible but lost to paperwork and reporting failures, and 707 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.
Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. North Dakota scores 50 of 100 on this model's ex parte capability index, a mid band; its eligibility system is Vision.
Key figures
| Measure | North Dakota |
|---|---|
| Expansion state | Yes |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 25,187 |
| Adults subject, strict definition | 23,561 |
| Adults subject, permissive definition | 23,090 |
| Share of expansion pool subject | 5.1% |
| Projected coverage loss by 2034 | 10,994 |
| Hardship exception status | No qualifying counties |
| Early implementer | No |
| Ex parte capability score (0 to 100) | 50 (mid) |
Who is subject in North Dakota
Of the 23,560 subject adults, 43% already work 80 or more hours a month and 47% are not working. 35% have a child under 14 at home. Among those not working, 56% report a disability and 17% are caregivers.
| Characteristic | Share of subject adults |
|---|---|
| Age 19-24 | 19% |
| Age 25-34 | 18% |
| Age 35-44 | 23% |
| Age 45-54 | 17% |
| Age 55-64 | 23% |
| Not working | 47% |
| 1 to 19 hours a month | 2% |
| 20 to 79 hours a month | 8% |
| 80 or more hours a month (meets the bar) | 43% |
| Not working: Disabled | 56% |
| Not working: Caregiver | 17% |
| Not working: Postpartum | 0% |
| Not working: Student | 1% |
| Not working: Other | 26% |
Why eligible people lose coverage
Of the 10,994 projected to lose coverage in North Dakota, 10,287 meet the requirement or qualify for an exemption but fail to document it. 3,017 of those are working people who cannot prove their hours through data the state can see, and 7,270 qualify for an exemption the state does not detect automatically.
| Group | Projected to lose coverage |
|---|---|
| Multiple part-time jobs (aggregation failure) | 1,171 |
| Variable shifts / on-call work | 636 |
| Self-employed (other) | 500 |
| Seasonal: agriculture, hospitality, food service | 197 |
| Cash-paid construction & trades | 176 |
| Full-time students not auto-verified | 175 |
| Volunteering / job training | 143 |
| Gig / courier (DoorDash, Uber, Lyft, Instacart) | 20 |
| Medically frail without auto-match | 2,706 |
| American Indian / Alaska Native (tribal exemption) | 1,392 |
| Parent caregivers of children ≤13 without auto-match | 1,088 |
| Caregivers of a disabled adult | 828 |
| Kinship caregivers (non-parent) of children ≤13 | 448 |
| SUD treatment not flagged in claims data | 407 |
| Recent incarceration (data-match gap) | 255 |
| Other categorical exemptions (foster, AYA cancer, SNAP/TANF) | 122 |
| Pregnancy / postpartum data lag | 24 |
Can the state renew people automatically?
The ex parte capability index blends the state's observed automatic-renewal rate (47% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. North Dakota's composite score is 50 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.
| Component | Score |
|---|---|
| Composite | 50 |
| Observed ex parte | 47 |
| Core capability | 47 |
| Data sources | 55 |
| Historical churn | 50 |
How subjects overlap across exemption categories
| Combination | Adults | Share |
|---|---|---|
| None of the four | 7,104 | 30.1% |
| Working ≥ qualifying hours / income | 4,795 | 20.3% |
| Medically frail | 3,897 | 16.5% |
| Working ≥ qualifying hours / income + Parent caregiver of child ≤13 | 3,346 | 14.2% |
| Parent caregiver of child ≤13 | 1,552 | 6.6% |
| Working ≥ qualifying hours / income + Medically frail | 837 | 3.5% |
| Working ≥ qualifying hours / income + Full-time student | 693 | 2.9% |
| Full-time student | 485 | 2.1% |
Counties in North Dakota
Subject adults concentrate: Cass County (5,799), Burleigh County (2,923), and Grand Forks County (2,451) account for 47% of the state's subject population.
| County | Adults subject | Subject rate | Projected loss | Poverty rate | Working-age population |
|---|---|---|---|---|---|
| Cass County | 5,799 | 4.8% | 2,706 | 11.0% | 121,326 |
| Burleigh County | 2,923 | 5.1% | 1,364 | 8.0% | 57,657 |
| Grand Forks County | 2,451 | 5.4% | 1,144 | 14.0% | 45,176 |
| Ward County | 1,786 | 4.3% | 833 | 9.0% | 41,722 |
| Morton County | 1,023 | 5.1% | 477 | 8.0% | 19,940 |
| Williams County | 985 | 4.2% | 459 | 7.0% | 23,310 |
| Stark County | 898 | 4.7% | 419 | 10.0% | 19,090 |
| Stutsman County | 637 | 5.1% | 297 | 13.0% | 12,482 |
| Richland County | 596 | 6.5% | 278 | 11.0% | 9,150 |
| McKenzie County | 382 | 4.5% | 178 | 13.0% | 8,396 |
| Barnes County | 358 | 6.0% | 167 | 13.0% | 5,946 |
| Rolette County | 353 | 5.6% | 165 | 25.0% | 6,328 |
| Ramsey County | 332 | 5.3% | 155 | 16.0% | 6,202 |
| McLean County | 324 | 6.4% | 151 | 7.0% | 5,077 |
| Walsh County | 322 | 5.7% | 150 | 10.0% | 5,650 |
| Mountrail County | 273 | 5.1% | 127 | 12.0% | 5,340 |
| Traill County | 255 | 5.8% | 119 | 7.0% | 4,411 |
| Mercer County | 254 | 5.7% | 119 | 10.0% | 4,426 |
| Pembina County | 232 | 6.7% | 108 | 9.0% | 3,481 |
| Bottineau County | 227 | 7.1% | 106 | 8.0% | 3,200 |
| Ransom County | 174 | 5.5% | 81 | 10.0% | 3,142 |
| Benson County | 170 | 5.9% | 79 | 27.0% | 2,860 |
| Dickey County | 161 | 5.9% | 75 | 9.0% | 2,730 |
| McHenry County | 159 | 5.8% | 74 | 10.0% | 2,752 |
| LaMoure County | 138 | 6.8% | 65 | 12.0% | 2,034 |
| Pierce County | 137 | 6.7% | 64 | 11.0% | 2,044 |
| Wells County | 132 | 6.9% | 62 | 11.0% | 1,926 |
| Cavalier County | 129 | 7.3% | 60 | 10.0% | 1,762 |
| Sargent County | 125 | 6.0% | 58 | 6.0% | 2,092 |
| Dunn County | 123 | 5.6% | 57 | 7.0% | 2,173 |
| Sioux County | 116 | 5.7% | 54 | 40.0% | 2,028 |
| Foster County | 106 | 5.8% | 49 | 8.0% | 1,810 |
| Emmons County | 102 | 6.3% | 47 | 7.0% | 1,604 |
| Kidder County | 101 | 8.5% | 47 | 13.0% | 1,196 |
| Bowman County | 100 | 7.0% | 47 | 11.0% | 1,432 |
| Nelson County | 91 | 6.0% | 42 | 11.0% | 1,512 |
| Hettinger County | 83 | 6.3% | 39 | 10.0% | 1,317 |
| Griggs County | 83 | 7.5% | 39 | 7.0% | 1,101 |
| McIntosh County | 80 | 6.5% | 37 | 14.0% | 1,234 |
| Divide County | 74 | 6.2% | 35 | 7.0% | 1,189 |
| Eddy County | 74 | 6.0% | 35 | 12.0% | 1,230 |
| Grant County | 69 | 6.5% | 32 | 15.0% | 1,073 |
| Renville County | 69 | 5.3% | 32 | 6.0% | 1,313 |
| Adams County | 68 | 6.5% | 32 | 13.0% | 1,052 |
| Oliver County | 67 | 7.9% | 31 | 12.0% | 848 |
| Burke County | 66 | 5.9% | 31 | 7.0% | 1,108 |
| Towner County | 66 | 6.2% | 31 | 14.0% | 1,070 |
| Logan County | 62 | 6.9% | 29 | 8.0% | 892 |
| Steele County | 58 | 6.9% | 27 | 13.0% | 850 |
| Golden Valley County | 53 | 6.8% | 25 | 13.0% | 779 |
| Sheridan County | 43 | 6.5% | 20 | 7.0% | 662 |
| Billings County | 39 | 7.2% | 18 | 11.0% | 545 |
| Slope County | 34 | 8.0% | 16 | 5.0% | 424 |
State brief and methodology
Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.